Correlates of Tricuspid Regurgitation as Determined by 3D Echocardiography: Pulmonary Arterial Pressure, Ventricle Geometry, Annular Dilatation, and Papillary Muscle Displacement

Abstract

Background-While it is understood that annular dilatation contributes to tricuspid regurgitation (TR), other factors are less clear. The geometry of the right ventricle (RV) and left ventricle (LV) may alter tricuspid annulus size and papillary muscle (PM) positions leading to TR. Methods and Results-Three-dimensional echocardiographic images were obtained at Emory University Hospital using a GE Vivid 7 ultrasound system. End-diastolic area was used to classify ventricle geometry: control (nϭ21), isolated RV dilatation (nϭ17), isolated LV dilatation (nϭ13), and both RV and LV dilatation (nϭ13).

Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty

“…Similar to mitral regurgitation, 18 an altered RV geometry displaces TV papillary muscle and position for chordae insertion, leading to inadequate leaflet coaptation, which closely correlates with the severity of TR. 19,20 The position of the papillary muscle is usually at the RV midcavity; thus, RV midcavity diameter measured in the present study may reflect the position of the anterior and septal papillary muscles of the RV. The larger diameter at the RV midcavity would thus suggest a greater displacement of the papillary muscle of the TV.…”

Dynamic Changes in Tricuspid Annular Diameter Measurement in Relation to the Echocardiographic View and Timing during the Cardiac Cycle

“…4,35,36 However, the stronger role of RA volume in determining TA size is a new finding, although not surprising, because the enlarged right atrium due to atrial fibrillation has been previously associated with TA dilatation and FTR development. 37 Because of the complex geometry of the right atrium, the independent correlation between RA volume and TA diameter could be detected only with the accurate RA volume measurement obtained by 3D echocardiography.…”

Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation

“…The pathophysiology of FTR has been investigated and critical TV deformations in its development have been proven to by guest on May 11, 2018 http://circimaging.ahajournals.org/ Downloaded from 3D Analysis of Functional Tricuspid Regurgitation be annular dilatation, 11,19 leaflet tethering, 8 and the ratio of total leaflet area:closure area associated with its coaptation status. 18 The TV tenting volume can be measured with 3D echocardiography and has been shown to be a major determinant of residual FTR after surgical annuloplasty.…”

“…22 In addition, factors leading to leaflet tethering are reportedly associated with RV remodeling such as spherical shape 9 and papillary muscle displacement. 11 However, in most of these previous studies, the study population was limited to FTR because of the pulmonary hypertension.…”